{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T03:49:20Z","timestamp":1782359360638,"version":"3.54.5"},"reference-count":47,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Prevention and Control of Diseases factors\u2014FATMA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: This study examined the associations of dietary animal (AP) and plant protein (PP) with all-cause mortality in an Italian population and assessed the potential effect modification by sex, smoking status, and overweight\/obesity (defined as BMI \u2265 25 kg\/m2). Methods: This longitudinal population-based study included 1350 adults (50.2% females), aged 40\u201374 years, recruited between 1991 and 1995, who were followed for all-cause mortality through the regional mortality registry until 2015. Dietary data were collected using a food frequency questionnaire, and protein composition was analysed within a compositional data analysis framework, modelling the balance of AP and PP within the overall macronutrient composition. The associations of protein balances with all-cause mortality were estimated using Cox proportional hazards models adjusted for potential confounders. Effect modification was evaluated through stratified analyses. Results: During follow-up, 405 deaths occurred. A greater AP relative to other macronutrients was associated with higher mortality overall (hazard ratio (HR): 1.37; 95% confidence interval (CI): 1.00\u20131.87) and in males (HR: 1.57; 95% CI: 1.05\u20132.33). In stratified analyses, these associations were restricted to ever smokers overall (HR 2.06, 95% CI 1.32\u20133.20), males (HR 1.90, 95% CI 1.18\u20133.06), females (HR 3.29, 95% CI 1.03\u201310.54), and to participants with normal weight (HR 1.91, 95% CI 1.07\u20133.41). No overall association was observed for PP. Among females, PP was associated with lower mortality in those with normal weight. Conclusions: The associations between AP and PP and mortality differed by sex, smoking status, and adiposity, supporting more tailored dietary recommendations.<\/jats:p>","DOI":"10.3390\/nu18122035","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:13:37Z","timestamp":1782195217000},"page":"2035","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Dietary Animal and Plant Protein Composition with All-Cause Mortality: 24-Year Population-Based Cohort Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9093-7643","authenticated-orcid":false,"given":"Federica","family":"Prinelli","sequence":"first","affiliation":[{"name":"Institute of Biomedical Technologies, National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5681-5861","authenticated-orcid":false,"given":"Antonio Giampiero","family":"Russo","sequence":"additional","affiliation":[{"name":"Epidemiology Unit, Agency for Health Protection of the Metropolitan City of Milan, Via Conca del Naviglio, 45, 20123 Milano, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"30824","DOI":"10.1073\/pnas.2015058117","article-title":"Global associations between macronutrient supply and age-specific mortality","volume":"117","author":"Senior","year":"2020","journal-title":"Proc. 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